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,-;10R OFFICE -USE: ' i APPLICATION FOR SANITATION PERMIT ............. ................. (Complete In Triplicate) Permit No.... �c/-.•• .......... 1- ........ ..... ...:/ ................................................... This Permit Expires 1 Year From Vale Issued Rate issued l!�_ Application is hereby made to the San Joaquin Local Health District for a -permit to conOruct and install the work herein i described. This application is made -in compliance with County Ordinance No. 549 and oxisting Rules and Regulations: JOB ADDRESS/LO N ... P`�._ .. ...�-7��. i^.4. ?G•^'.. �.e .! ..............CENSUS TRACT _......................... - - Owner's Name ...�f'! F.t-- '! _ , . ... - .. .......... ..................:................phone ...;......,........ . . Address.. !YT_'. ................. ty '''�'................................................ . Contractor's Name7G.r...............License # �.�' SQL/ Phone ` Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Own 0 Motel ❑ Other.... ......... I .............................. Number ther.............I.........._..._........_----- Number of living units:..__ Number of bedrooms ......Garbage Grinder 7--C-5-Lit Size .., "Q. s'......-•_ I Water Supply: Public System and name........................................................ .......... _.......... ............ ........ ........... Private Mr Character of soil to a depth of 3 feet: Sand X Silt ❑ Clay ❑ Peat ❑ Sandy Loam [j Clay Loam 0 i Hardpan 0 Adobe ❑ Fill Material ............ If yes, type (Piot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) J t NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 208 feet,) PACKAGE TREATMENT SEPTIC TAN Od1 Size... 410.A.1'ct...-....... ... Liquid Depth ZA................ Capacity........5_84.... Type Axr-*&%/ Matertaf:Z�. . C :'-fACt No. Compartments _. ............ �J I�� r At Distance to nearest: Well .. �.............. .........:.Foundation .�!.!!--......._..... Prop. Line .... LEACHING LINE O No. of lines _.r - ............. Length of each Iinea.3...... Total Length .411';-.. ............... .. k ,t f� ' 'D' Box ...�.. Type Filter Material ...I....y....__._.Depth Filter M-zter£al,.-..-zr............ I ................. Distance to nearest: Well ........................ Foundation ----_--- ............. Property line ........................ *07 ' T [ j Depth .. '�....._... Diameter �x�_G Number -.--_... L..._........ Rock Filled Yes No Q FJ yG7 C7' Water Table Depth ........ .................. ...................... Rock Size .-1_^ . -- t!�/ Distance to nearest: Well ........................................Foundation ................... Prop. Line ...................... REPAIR/ADDITION (Prev. Sanitation Permit # ........ -----------_-------..._----------- Date ............. .................... Septic Tank (Specify Requirements) ------------------ ....................... ............................ .-................. _......................................... Disposal Field (Specify Requirements) ---------------•-•----............----.._..._.............................................._._...... .................................... ........................................................ --------------------------------- I ...... .............. ...................... ................................................... I............................ ............. -- ......... .....••-....................... ........ ............... ....... f(Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Sar+ Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health, District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in such manner f as to become subject to Workman's Compensation laws. of California." Signed ._........ Owner By...-....� "" title ....................... ............... Ilf other than owner) FOR DEPARTMENT USE ONLY iAPPLICATION ACCEPTED BY ....... Q ^- :................................ DATE ...... // _/ " �. ...... I BUILDING PERMIT ISSUED .......................... ..........----.............. ...---...... DATE ------ ...:.................. ............... ADDITIONAL COMMENTS ................... ........... ............................... ....... ....................... F ............... ......................... I ....... ... --... :,..�...._.. .-- •-•---•-•_.. .... Final Inspection by; . .........................................__....._......_.............._...._......._.................Date �/-'�.`7._`%....:.._.._... f ' EH 13 2h 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M